Provider Demographics
NPI:1346006087
Name:ACOSTA, BRANDON (RBT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 NW 68TH AVE APT I203
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3956
Mailing Address - Country:US
Mailing Address - Phone:786-213-0144
Mailing Address - Fax:
Practice Address - Street 1:18111 NW 68TH AVE APT I203
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3956
Practice Address - Country:US
Practice Address - Phone:786-213-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician